Trabecular bone score and bone mineral density in patients with long‐term controlled acromegaly

Abstract

Objective Acromegaly is associated with increased vertebral fracture (VFs) risk not correlated to bone mineral density (BMD). Trabecular bone score (TBS), related to bone microarchitecture, provides information on bone strength. This cross‐sectional study considered the usefulness of TBS and BMD to assess bone status in long‐term controlled acromegalic patients. Design, patients, measurements 26 acromegaly patients (14 female and 12 males) were included in the study. A further 117 subjects were recruited as controls (58 females and 57 males). BMD was measured using dual‐energy X‐ray absorptiometry (DXA), TBS was obtained applying Medimaps software 2.0. Biochemical parameters were determined by standardized techniques. Results 73% of patients with acromegaly exhibited normal lumbar spine (LS) BMD. TBS was normal in 38% of acromegalic patients and partially degraded or degraded in 31% of patients, respectively. No differences were found in LS BMD between acromegalic patients and controls. TBS values were significantly lower in patients with acromegaly (1.27 ± 0.13 vs. 1.35 ± 0.17, p = .01). Postsurgical remission was associated with higher TBS values (1.35 ± 0.10 vs. 1.23 ± 0.13, p = .02) and pituitary radiotherapy treatment with lower TBS values (1.18 ± 0.12 vs. 1.31 ± 0.12, p = .004). On multivariate analysis, age, BMI and LS BMD were predictors of TBS changes in patients with acromegaly (p < .05). Conclusions Patients with long‐term controlled acromegaly can exhibit deterioration of bone microstructure measured with TBS, despite BMD measurement not showing bone loss. Our study suggests that TBS is useful for monitoring the bone status changes in acromegalic patients.

Trabecular Bone Score as a Reliable Measure of Lumbar Spine Bone Microarchitecture in Acromegalic Patients

“…In the present study, we found that TBS values were lower in acromegalic patients compared to age, BMI, and sex-matched healthy controls, while no significant differences were observed in BMD values between the two groups, both at lumbar and femoral sites. These data are in line with the results reported by other authors, although some studies did not find significant differences in TBS values between patients and matched controls [ 23 , 41 , 42 , 43 , 45 , 46 , 47 ]. Furthermore, we observed that both BMD and TBS values were significantly lower in hypogonadal patients compared to the eugonadal ones, thus confirming the pivotal role of gonadal status on both bone density and quality in acromegaly [ 6 , 40 ].…”

“…In line with previous findings, we observed a significant inverse correlation between TBS values and age in acromegalic patients, although this correlation was not found in the control group [ 23 , 37 , 43 , 46 ].…”

“…Currently, few studies have analyzed TBS in patients with acromegaly [ 23 , 24 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ]. In most cases, the authors reported lower TBS values in acromegalic patients compared to healthy subjects.…”

Trabecular Bone Score and Osteoprotegerin as Useful Tools in the Assessment of Bone Deterioration in Acromegaly

“…Correspondingly, Calatayud et al. revealed significantly lower TBS values in controlled acromegalic patients, despite no difference in LS BMD ( 31 ). In another study, Goldang et al.…”

The Negative Impacts of Acromegaly on Bone Microstructure Not Fully Reversible

“…Using impact micro-indentation, Malgo et al illustrated that acromegaly patients in remission have impaired cortical bone strength relative to healthy controls (21). Furthermore, the trabecular bone score (TBS) of acromegaly patients continues to decline after the disease had been rigorously controlled (22,23). Therefore, we should pay more attention to evaluating bone microstructure and preventing fractures in acromegaly patients, even if the disease had been satisfactorily controlled.…”